Anxiety Disorders and OCD Overview

What are anxiety disorders as described in DSM-5-TR?

Anxiety disorders share features of excessive fear and anxiety and related behavioral disturbances.

What is the prevalence of anxiety disorders worldwide?

Anxiety disorders are the most prevalent mental disorders worldwide according to the Global Burden of Disease Study.

What is Separation Anxiety Disorder?

Separation Anxiety Disorder involves excessive fear or anxiety about being separated from attachment figures, indicated by at least three symptoms lasting for at least four weeks in children and adolescents or six months in adults.

What are some symptoms of Separation Anxiety Disorder?

Symptoms include excessive distress when anticipating separation, reluctance to go to school or work, and physical complaints when separation is anticipated.

What can trigger the development of Separation Anxiety Disorder?

It often develops after exposure to stressful events such as parental divorce or the death of a relative or pet.

What is school refusal in the context of Separation Anxiety Disorder?

School refusal is a manifestation where children want to stay with caregivers instead of going to school, often accompanied by physical symptoms and emotional distress.

What is the preferred treatment for Separation Anxiety Disorder?

Cognitive-behavior therapy (CBT) that includes psychoeducation, exposure, relaxation techniques, and cognitive restructuring.

How can the effectiveness of CBT for children with Separation Anxiety Disorder be increased?

Effectiveness can be increased when CBT is combined with parent training.

What is the initial treatment goal for children with school refusal due to Separation Anxiety Disorder?

The initial goal is to get the child back to school to reduce the risk of social isolation and academic failure.

What is Specific Phobia?

Specific Phobia involves intense fear or anxiety about a specific object or situation, leading to avoidance or enduring it with distress.

What criteria must be met for a diagnosis of Specific Phobia?

Fear or anxiety must be out of proportion to the actual danger, persistent for at least six months, and cause significant distress or impaired functioning.

What are the types of Specific Phobia?

Types include animal, natural environment, blood-injection-injury, situational, and other.

Which gender is more commonly affected by Specific Phobia?

Specific phobia is about twice as common in girls than boys, though rates vary by phobic stimuli.

What is the typical age of onset for Specific Phobia?

The mean age of onset is about 10 years of age.

What does Mowrer's two-factor theory explain regarding specific phobias?

It attributes phobic reactions to a combination of classical and operant conditioning.

How does classical conditioning contribute to the development of specific phobias?

It occurs when a previously neutral object or event becomes a conditioned stimulus that elicits anxiety after being paired with an unconditioned stimulus.

What role does operant conditioning play in specific phobias according to Mowrer's theory?

It involves learning that avoiding the conditioned stimulus allows a person to avoid experiencing anxiety, negatively reinforcing avoidance behavior.

Why is the conditioned response in specific phobias not extinguished?

Because the person never has opportunities to experience the conditioned stimulus without the unconditioned stimulus.

What is the primary treatment method for specific phobias?

Exposure and response prevention to extinguish the conditioned anxiety response.

What is flooding in the context of exposure therapy?

It involves immediately exposing a client to their most feared object or situation until their anxiety subsides.

What is graded exposure in the context of treating phobias?

It involves constructing a list of anxiety-inducing situations, starting with the least anxiety-provoking and progressing to the most anxiety-provoking.

How is graded exposure typically structured?

It consists of about 10 situations that elicit anxiety, starting from low to high levels of anxiety.

What example illustrates graded exposure for a fear of heights?

The first item might be standing on a chair, and the last item could be riding in a ski lift.

What is the benefit of conducting graded exposure in vivo?

The therapist may accompany the client during the initial exposure to each item, providing support.

Which type of exposure has been found to be more effective, in vivo or imagination?

In vivo exposure is generally more effective than exposure in imagination.

What has research indicated about therapist-led exposure versus self-directed exposure?

Therapist-led exposure is more effective than self-directed exposure.

What emerging method may be as effective as in vivo exposure for certain phobias?

Virtual reality exposure.

For which specific phobias has virtual reality exposure shown effectiveness?

Fear of heights (acrophobia) and fear of flying.

How can exposure therapy be enhanced for individuals with the blood-injection-injury subtype of phobia?

By combining it with applied tension to prevent fainting.

What physiological response characterizes the blood-injection-injury subtype of phobia?

A brief increase in heart rate and blood pressure followed by a decrease that can cause fainting.

What defines Social Anxiety Disorder (Social Phobia)?

A fear or anxiety reaction to at least one social situation where the person may be exposed to scrutiny by others.

What must a person fear in order to be diagnosed with a specific anxiety disorder?

The person must fear that exhibiting symptoms in the situation will be negatively evaluated.

What are the criteria for the fear or anxiety in this diagnosis?

Fear or anxiety must be excessive for the actual threat posed by the situation, persistent for at least six months, and cause significant distress or impaired functioning.

What are the first-line treatments for this anxiety disorder?

Cognitive behavior therapy and antidepressant medications (SSRIs and SNRIs).

What techniques are incorporated in cognitive behavior therapy?

Cognitive restructuring and exposure.

How does guided internet-delivered cognitive behavior therapy compare to face-to-face therapy for adults?

It is equivalent in terms of symptom reduction for this disorder and other anxiety disorders.

What has research found about school-based cognitive behavior therapy?

It has beneficial effects for children and adolescents.

What characterizes Panic Disorder?

It involves recurrent unexpected panic attacks, with at least one attack followed by persistent concern about additional attacks or significant maladaptive changes in behavior.

How does the DSM-5-TR define a panic attack?

An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, involving at least four of 13 symptoms.

What are some common symptoms of a panic attack?

Heart palpitations, sweating, nausea, dizziness, fear of losing control, fear of dying, paresthesia, derealization, or depersonalization.

What must be ruled out before diagnosing Panic Disorder?

Medical conditions such as hyperthyroidism and cardiac arrhythmia.

What is panic control treatment?

A comprehensive cognitive-behavioral intervention that combines interoceptive exposure with relaxation and other techniques for controlling symptoms.

What is interoceptive exposure?

Deliberately exposing the person to the physical symptoms associated with panic attacks.

What medications have been found useful for alleviating panic attacks?

Some antidepressants (e.g., imipramine) and benzodiazepines.

What is a downside of using antidepressants and benzodiazepines for panic disorder?

They are associated with a high relapse rate when used alone.

What is Agoraphobia?

Marked fear or anxiety occurring in at least two of five situations, such as using public transportation or being in enclosed spaces.

What must a person fear or avoid in situations related to Agoraphobia?

Concern that escape will be difficult or that help will be unavailable if panic symptoms or other incapacitating symptoms develop.

What are the five situations associated with Agoraphobia?

Using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, and being outside the home alone.

What are the key characteristics of agoraphobia?

Excessive fear or anxiety about situations that almost always elicit fear, situations that are actively avoided or endured with intense fear, and persistent symptoms lasting at least six months causing significant distress or impaired functioning.

What is the first-line treatment for agoraphobia?

In vivo exposure and response prevention.

What type of exposure is most commonly used in treating agoraphobia?

Graded exposure.

What alternative exposure method may have better long-term effects for agoraphobia?

Intense (non-graded) exposure.

What is the role of learning in the effectiveness of exposure therapy for agoraphobia?

Learning to tolerate high levels of fear and anxiety is the key contributor to the effectiveness of exposure.

What defines Generalized Anxiety Disorder (GAD)?

Excessive anxiety and worry about multiple events occurring on most days for at least six months, with difficulty controlling the worry and significant distress or impaired functioning.

What are the three symptoms required for a GAD diagnosis?

Restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, or sleep disturbance.

How does GAD differ from nonpathological anxiety?

Individuals with GAD feel unable to control their worrying and worry about a larger number of events, often with associated somatic symptoms.

What age-related trends are noted in the content of worries for GAD?

Children and adolescents worry about catastrophic events and competence in sports/school, while older adults worry about health and safety.

What is the most common comorbid disorder for GAD?

Major depressive disorder.

What are some risk factors for developing GAD?

Family history of anxiety disorders, behavioral inhibition, neuroticism, harm avoidance, and exposure to childhood trauma or chronic stress.

Which brain regions are associated with GAD according to neuroimaging studies?

Ventrolateral and dorsolateral prefrontal cortex, anterior cingulate cortex, posterior parietal cortex, amygdala, and hippocampus.

What does reduced connectivity between the prefrontal cortex and amygdala suggest in GAD?

Weak top-down control of amygdala reactivity.

What is the most effective treatment for GAD?

Cognitive-behavior therapy (CBT), potentially combined with pharmacotherapy.

What are the first-line medications for GAD?

SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors).

What medication may benefit individuals with GAD who do not respond to antidepressants?

Buspirone (Buspar) or a benzodiazepine.

What has been studied in relation to GAD and other anxiety disorders?

The effects of combining motivational interviewing with cognitive-behavior therapy.

What is the effectiveness of combined treatment for Generalized Anxiety Disorder (GAD)?

The combined treatment is effective for GAD, especially when symptoms are severe.

What does research suggest about the combined treatment for Obsessive-Compulsive Disorder (OCD)?

It is a promising but still unproven approach.

What disorders are included in the DSM-5-TR under Obsessive-Compulsive and Related Disorders?

Obsessive-Compulsive Disorder (OCD), body dysmorphic disorder, and other related disorders.

What are the key characteristics of Obsessive-Compulsive Disorder (OCD)?

OCD involves recurrent obsessions and/or compulsions that are time-consuming and cause significant distress or impaired functioning.

What are obsessions in the context of OCD?

Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted, causing marked anxiety or distress.

What are compulsions in the context of OCD?

Repetitive behaviors or mental acts performed in response to an obsession or according to rigid rules, aimed at reducing anxiety.

What factors are indicated by specifiers in OCD?

They indicate the person's level of insight into their beliefs and the presence of tics.

How does the prevalence of OCD differ between males and females?

Males have an earlier age of onset and a higher prevalence rate in childhood, while females have a higher prevalence rate in adulthood.

What percentage of individuals with OCD have comorbid psychiatric disorders?

About 90%.

What is the most common comorbid disorder with OCD?

Anxiety disorder.

What neurobiological factors are associated with OCD?

Lower-than-normal levels of serotonin and elevated activity in the caudate nucleus, orbitofrontal cortex, cingulate gyrus, and thalamus.

What is the first-line evidence-based treatment for OCD?

Exposure and Response Prevention (ERP), also known as exposure and ritual prevention.

How does Exposure and Response Prevention (ERP) work?

It involves exposing patients to anxiety-arousing thoughts, objects, or situations and preventing them from engaging in ritualistic behaviors.

What does research suggest about the effectiveness of combined treatment for OCD?

The combined treatment of ERP with an SSRI or clomipramine may be most effective in certain circumstances.

What are some effective treatments for OCD besides ERP?

Cognitive-behavior therapy and acceptance and commitment therapy.

What is Body Dysmorphic Disorder?

A disorder involving preoccupation with a perceived defect or flaw in physical appearance that is not observable or appears minor to others.

What behaviors do individuals with Body Dysmorphic Disorder perform?

Repetitive behaviors or mental acts such as mirror checking or skin picking.

What must the preoccupation in Body Dysmorphic Disorder cause?

Significant distress or impaired functioning.

What misconceptions might individuals with Body Dysmorphic Disorder have?

They may believe that others are mocking or taking special notice of them because of their physical appearance.